LB-456087-4 GNETIC RESONANCE IMAGING BASED AL LEAD CARDIAC ESYNCHRONIZATION THERAPY: PROSPECTVE EFT UNDLE RANCH ACING STUDY (MADURAI LBBP STUDY)

Cardiac resynchronization therapy (CRT) is a class I indication for LVEF ≤35%, heart failure(HF) and LBBB. Patients with LBBB associated nonischemic cardiomyopathy (LB-NICM) minimal or no scar by cardiac magnetic resonance(CMR) imaging may be excellent prognosis following CRT. Left bundle branch pacing(LBBP) can achieve in patients Cost of CRT-P/D precludes its utilization developing countries. Aim our study was to prospectively assess feasibility efficacy LBBP optimized dual chamber pacemaker(LOT-DDD) risk-stratified CMR LB-NICM LVEF≤35%. Pts LB-NICM, LVEF≤35% HF were enrolled from 2019 2022. performed risk-stratify prior device implantation. If the burden <10%, LBBP+pacemaker only (Group I) if >10%, LBBP+ICD(Group II) performed. In pts complete correction, LOT-DDD pacemaker implanted. incomplete, LOT-CRT Serial echo, hospitalization(HFH), arrhythmias, mortality assessed. Primary endpoints 1.Echocardiographic response(ER)– absolute change LVEF≥15% at 6 months; 2.Composite time death, first occurrence HFH sustained VT/VF. Secondary hyper-response(EHR - LVEF≥50% LVEF≥20%) 12 2.Indication ICD upgradation(persistent <35% months VT/VF). 120 enrolled. LGE-CMR showed ≤10% 109 patients(90.8%). 4 withdrew opted LBBP+ICD. done 101 LOT-CRT-P patients(Group I,n=105). Scar >10% 11 who underwent II). Mean age 58±10yrs,female 63%,HTN 41%,DM 39%. QRS duration reduced 170±20ms 117±11ms(p<0.0001). During mean follow-up 21±12 months, primary endpoint ER observed 80%(68/85 pts) Group vs 27%(3/11 II(p-0.0001). composite VT/VF occurred 3.8% group 33.3% II(p<0.0001). increased 30±4% 50±12% I(p<0.0001) compared 27±2% 42±11% II(p=0.0002). will presented. guided CRT using appears safe feasible approach has potential reduce healthcare cost. Future randomized trials comparing CRT-D necessary establish this cost-effective therapy.